Friday, January 22, 2010

Physician and Author Discusses Cultural Challenges

by Holly Hosler

During grand rounds at Sinai Hospital yesterday, scores of LifeBridge Health doctors and residents heard physician and writer Danielle Ofri, M.D., speak about the cultural challenges presented when meeting with patients.

Dr. Ofri’s talk, titled “Journeys with our patients: multiculturalism in a two-person canoe,” opened with a passage from her book Incidental Findings: Lessons from My Patients in the Art of Medicine. She read about her patient, Mrs. Uddin, a 35-year-old Bangladeshi and observant Muslim, who always complained of pain. “Why so much pain? Why, doctor, why?” the patient would moan in broken English.

Mrs. Uddin’s test results showed she was physically healthy; rather, her pain was a psychosomatic result of depression. Unfortunately, Mrs. Uddin continually resisted Dr. Ofri’s advice to see a psychiatrist and take medication that would alleviate her depression. Yet Mrs. Uddin frequented the doctor’s office month after month for eight years, and Dr. Ofri grew to despise her and everything about her – religious veil included – simply because there was nothing she could do to help or get through to her patient.

Dr. Ofri also documented this saga in a piece in the New England Journal of Medicine called “Torment.” She says she published it to “face up to the parts of me that I’m not proud of” and to expose areas in which doctors need to learn to be more sensitive to their patients’ cultural differences. Later in the lecture, Dr. Ofri revealed that when she openly asked Mrs. Uddin and her daughter about their Muslim veils – why they wore them and why they were of different styles – her patients warmed to her in ways previously unimaginable. Instead of being offended by her questions about their cultural practices, they were eager to discuss these parts of their lives. For the first time in her presence, says Dr. Ofri, Mrs. Uddin became “delighted” and “buoyant.”

“All the multicultural education we receive … seems so limited,” says Dr. Ofri.

Generalizations about different cultural groups – e.g., Hispanics are religious and value family and camaraderie – feel so “awkward” and “pitiable,” she says. On the other hand, when doctors practice cultural neutrality, patients perceive it as coldness and indifference. As a solution, Dr. Ofri suggests that doctors take “journeys” with their patients and coworkers from different cultural backgrounds by asking questions and gaining insights into their different perspectives. And she also warned us to be careful not to stereotype against ourselves, which she learned after failing to notice a key symptom in one of her patients whom she perceived to be like her – “white, female and neurotic.”

“Being a good doctor is so much harder than knowing all your medicine,” Dr. Ofri observed. By getting to know one’s patients, doctors will often find that their initial assumptions about their patients and the patients’ realities will be vastly different.

To see if Dr. Ofri is speaking in your city, click here.

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